tbuckley/cabot-search huggingface dataset:
Prophylactic cerebral irradiation or active brain magnetic resonance imaging surveillance in small-cell lung cancer patients (EORTC-1901: PRIMALung).
Authors: Antonin Levy, Thierry Berghmans, Nicolaus Andratschke, Giulia Leonetti, Michael Koller, Corinne Faivre-Finn
Journal: Journal of Clinical Oncology (2023)

TPS8614 Background: PRIMALung is an EORTC-sponsored study. Primary objective is to show that overall survival with brain MRI surveillance alone is non-inferior to brain MRI surveillance combined with PCI in patients with SCLC. PCI is currently SOC in most institutions, but can be associated with neurocognitive toxicity and impact quality of life. 600 patients will be recruited from 50 EORTC centres in 10 countries. This study is currently recruiting and will play an important role in clarifying whether MRI surveillance is a viable strategy in SCLC. Furthermore, it will answer important questions about the role of PCI in the era of immunotherapy, particularly in ES-SCLC. Methods: Key eligibility: ECOG performance status ≤ 2 patients with SCLC (Limited or Extensive-Stage, stage I-IV) who did not progress after (≤ 16 weeks from day 1 of last cycle of chemotherapy to randomisation) completed standard therapy. Absence of progression, brain metastases or leptomeningeal disease after completing therapy. Trial Interventions: Patients will be randomised 1:1 to receive brain MRI surveillance with or without PCI (25Gy in 10 fractions). Primary objective - to show that overall survival with brain MRI surveillance alone is non-inferior to brain MRI surveillance combined with PCI. Secondary objectives - cognitive failure-free survival, quality of life and acute/late toxicities according to CTCAE v5.0. The trial was open to recruitment on 27/10/2022. Three countries open to date (Belgium, Switzerland, UK). Further sites in France, Poland and Austria will be open to recruitment Q1 2023. The first patient has been randomized on the 4 th of January 2023. Further information: https://clinicaltrials.gov/ct2/show/NCT04790253 contact: 1901@EORTC.org. Clinical trial information: NCT04790253 .
Time to colonoscopy and insurance status at an FQHC.
Authors: Hardik Dand, Ushan Ranasinghe, Miranda Hart
Journal: Journal of Clinical Oncology (2023)

e18543 Background: In 2021, Federally Qualified Health Centers (FQHCs) cared for over 30 million patients, 68.7% of whom had Medicaid or were uninsured. FQHCs face challenges to obtain colonoscopies for patients, as many specialists are outside of network coverage or do not accept uninsured patients. As such, many FQHCs use fecal immunochemical testing (FIT) as an initial colon cancer screen. A positive FIT requires a follow-up colonoscopy. Follow-up colonoscopy rates range from 18% to 57% at FQHCs nationally. This study investigates a possible relationship between insurance status and time to colonoscopy after a positive FIT at an FQHC in Chicago. Methods: We performed a retrospective chart analysis. Charts were obtained from the electronic health record by an informatics team. Patients aged 45 years or older with a positive diagnostic FIT between 12/2020 and 12/2021 were selected. We evaluated insurance status, date of positive FIT, date of colonoscopy when applicable, and colonoscopy results. Results: A total of 314 patients were identified of which, 169 (53.8%) were insured and 145 (46.2%) were uninsured. From the 44 (13.7%) patients that completed colonoscopies, 25 (58.1%) were insured and 18 (41.9%) were uninsured. A Chi-square test revealed no significant relationship between patients who did or did not have a colonoscopy and insurance status. The mean number of days between positive FIT and colonoscopy was 124.7 (SD 64.7) and ranged from 38 to 309 days. A two-sample t-test found no significant difference in the mean time to colonoscopy between insured and uninsured patients. Colonoscopy results revealed the majority of patients (N = 23, 53.5%) had benign tumors with only one patient having cancer. Conclusions: In this study, insurance status did not impact time to obtain a colonoscopy. Only 13.7% of patients had a colonoscopy, lower than national rates. Several factors likely contributed to low follow-up rates, including the COVID-19 pandemic, insurance type, language barriers, and colonoscopy scheduling wait times. Establishing strong hospital partners, use of reminder calls, education and encouragement from providers, and emphasizing follow-up could improve colonoscopy rates. [Table: see text]
Ask Questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics.
Authors: Lauren M. Hamel, Tanina Foster Moore, Larissa H. Mattei, Hyejeong Jang, Seongho Kim, Kimberly Keaton-Williams, Voncile M. Brown-Miller, Susan Eggly
Journal: Journal of Clinical Oncology (2023)

e24185 Background: High-quality, patient-centered communication is not experienced equitably across patient populations, likely contributing to healthcare disparities. Question Prompt Lists (QPL) improve patient active participation and other aspects of patient-physician communication in diverse populations and settings. This descriptive, single-arm study assessed the implementation and patient perceptions of a previously-developed, evidence-based QPL, the ASQ brochure, across a network of oncology clinics providing care in a diverse population across Michigan. Methods: The QPL was revised in collaboration with community and physician stakeholders. Implementation was assessed through the reach, adoption, and efficacy domains of the RE-AIM framework. Eligible patients had a cancer diagnosis and were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before their appointment, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and univariable and multivariable linear mixed-effects models. Results: Reach: A total of 81 patients participated with a consent rate of 68.3%. Self-identified racial/ethnic groups were representative of the population served by the clinic network (72.4% white, 21.0% black, 3.7% American Indian/Native Alaskan, and 1.2% Mexican/Hispanic). Adoption: All eight invited clinics participated and recruited patients. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Patient perceptions of the ASQ brochure were overwhelmingly positive. Conclusions: The implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Findings suggest this simple, evidence-based communication intervention should be implemented widely in similar clinical contexts.
Real-life efficacy of nivolumab plus ipilimumab combination in untreated, unresectable malignant pleural mesotheliomas: Result of French early access program—MESOIMMUNE – GFPC 04-2021.
Authors: Olivier Bylicki, Florian Guisier, Catherine Daniel, Aurélie Swalduz, Emmanuel Grolleau, Marie Bernardi, Stephane Hominal, Nicolas Cloarec, Simon Deshayes, Judith Raimbourg, Remi Veillon, Youssef Oulkhouir, Clarisse Audigier-Valette, Aurélien Gobert, Lionel Falchero, Lise Thibonnier, Matthieu Chasseray, Christine Raynaud-Donzel, Chantal Decroisette, Laurent Greillier
Journal: Journal of Clinical Oncology (2023)

8536 Background: The SOC for unresectable malignant pleural mesothelioma (MPM) has changed in 2020 with the combination nivolumab plus ipilimumab (NIVO+IPI) results of CheckMate 743 study. As CheckMate 743 was therapeutic trial in selected MPM patients (pts), additional data would be of interest to confirm the results in real-life setting. Methods: The present multicenter, retrospective study assessed the outcomes of NIVO+IPI, via an early access program (EAP) in France, in pts with treatment naïve unresectable MPM. The primary objective was investigator-assessed real world progression-free survival (rwPFS) from initiation of NIVO+IPI, defined as time from first dose of NIVO+IPI to first documentation of objective disease progression or death from any cause. The secondary objectives were real world OS (rwOS), objective response rate (ORR), and safety of NIVO+IPI combination. Results: From April 1, 2021 to Feb 15, 2022 (last day of EAP) there were 143 pts included out of 350 pts treated by EAP for unresectable MPM in 44 centers. Population characteristics are described in the table. With a median follow-up of 14.1 months, median rwPFS was 7.8 months (95%CI 6.2-9.5). rwPFS rates no differ according to histological subtypes: rwPFS for epithelioid MPM was 8.1 months (95%CI 6.0-12.6) and 7.4 months (95% CI 5.3-11.2) for other histological subtypes. The median rwOS was not reached (NR), 1-year survival rate was 65% (95% CI 57-75%). Median rwOS was NR and 13.1 (95% CI 7.8- NA) in epithelioid and non-epithelioid MPM, respectively. At 1 year, 71.2% of pts with epithelioid MPM are still alive versus 51.2% in pts with other histological subtypes. ORR was 23.9% (95% CI 16.9-32.0%) with median time to response of 3.68 months (2.33-5.09) after introduction of NIVO+IPI. Disease control rate was 80.4%. Grade 3-4 adverse events (AE) occurred in 37.8%. Severe immune-related AE occurred in 13.9% of patients. Five deaths were associated with treatment-related AEs according to investigators judgment. Conclusions: While pt’s characteristics differed from the pivotal trial, notably with older and unselected patients, efficacy outcomes that we observed here compares favorably with CheckMate 743 results. Tolerance looks acceptable in real-life setting despite 5 toxic deaths reported. Extended follow-up of our cohort will allow consolidation of the results. Clinical trial information: NCT05308966 . [Table: see text]
Identifying associations between race and gender in the incidence and mortality of patients with multiple myeloma.
Authors: Aditya Kumar Ghosh, Nicole McGuire, Ruben Ruiz Vega, Hossny Alaws, Comfort Adewunmi, Oluseyi Abidoye, Andria P Caton, Andrew Thomas Johnson
Journal: Journal of Clinical Oncology (2023)

e20052 Background: Multiple Myeloma (MM) is a plasma cell malignancy due to proliferation of malignant clonal plasma cells. Prior studies have shown that overall incidence of MM was 8.47 per 100,000 individuals. It has also been seen that the incidence of MM has trended upwards in non-Hispanic white (NHW) males and non-Hispanic blacks (NHB) across all age groups. This retrospective, database-driven population study sought to further assess racial and gender-based differences in the trends of the incidence of MM and mortality from MM. Methods: Data obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry 17 were available to assess trends of multiple myeloma incidence and mortality from 2000 to 2019. Trends were described as average annual percentage change (APC) rates. Results: A total of 102,467 MM patients were identified in this data set; 56,508 (55.1%) were males and 45,949 (44.8%) were female. The distribution of MM by race was as follows (in order from highest to lowest): Non-Hispanic White [NHW] patients was 63.2% (N = 64,776), Non-Hispanic Black [NHB] patients was 18.6% (n = 19,099), Hispanic patients was 11.6 % (11,841), Non-Hispanic Asian [NHA] patients was 5.6% (5,769), and Non-Hispanic American Indian [NHAI]/Alaska Native patients was 0.5% (523). Incidence of MM (cases per 100,000 persons) was highest in males (7.5; 95% CI: 7.5, 7.6) and blacks (13; 95% CI: 12.8, 13.2). Overall trend in the incidence of MM has increased significantly for all gender and ethnicity groups over the period from 2000-2019, except for NHA patients. The incidence-based mortality of MM was highest in male (5.2; 95% CI: 5.2, 5.3) and black (8.7; 95% CI: 8.5, 8.8) patients. The overall incidence-based mortality increased significantly in males APC 4.1% (95% CI: 2.2,5.9; p &lt; 0.001), females APC 3.6% (95% CI, 1.8,5.5; p &lt; 0.001) and all ethnicities - NHW patients APC 4.1%, (95% CI, 2.2,6.0; p &lt; 0.001), NHB (APC 4.2%, 95% CI, 2.1,6.3; P &lt; 0.001), NHAI (APC 4.7%, 95% CI, -2.2,7.2; p &lt; 0.001), NHA (APC 3.0%, 95% CI: 0.8,5.2; P = 0.009) and Hispanic (APC 2.9, 95% CI:1.1,4.7; P = 0.003). Conclusions: Population-based trends in MM incidence and mortality, as reported in this study, were increased commensurate with prior reports. Of note, mortality was noted to be highest amongst the NHB and male populations, indicating a need for further research focused efforts in this potentially high-risk population.
Utilization of early integrated palliative medicine among patients with metastatic solid tumor cancers: Findings from a safety net medical center treating a majority African American population.
Authors: Aneesha Ananthula, Patrick L Sweeney, Pallavi Mishra, Kanika Gupta, Jason Worley, Brandon Carroll, Dharmini Manogna, Michael Hoerger, Rajasree Pia Chowdry, Sonia Malhotra
Journal: Journal of Clinical Oncology (2023)

12128 Background: Early interdisciplinary Palliative Medicine (PM) involvement is known to provide significant benefits when added to usual oncology care, however a study by Ferrari et al looking at oncologic patients between 2001 to 2016 found that only 36% of patients with cancers with a very poor prognosis received Palliative Medicine services. In 2016 ASCO provided a practice guideline recommending specialty PM services to begin within 8 weeks of diagnosis. Our study aimed to assess the integration of the above recommendation in a newly built academic, safety net hospital serving as a regional tertiary healthcare facility with a newly built PM service that included a free-standing outpatient clinic. Methods: This is a retrospective cohort study of all patients on the tumor registry with de novo stage IV cancer diagnosed in a four-year period from 2018 to 2021. Patient data was collected from the electronic medical record (EMR) and included demographics, health history, PM utilization, and advance care planning documentation. Logistic regression was used to analyze key predictors of PM utilization and advance care planning. Results: The majority of patients (N = 510) were African American (race: Black [56.5%], White [35.7%], all other racial groups [7.8%]; mean age = 59.8 [range from 18 or over 90]; sex: 60.6% male). Diagnoses included gastrointestinal (38.2%), thoracic (27.8%), genitourinary (26.3%), and other (7.7%) cancers. Out of the group, 60.5% of the patients received PM services and 55% of those had a visit within the ASCO recommendations of 8 weeks. A surprising 32.7% of those referred to PM had a first visit within the first 2 weeks via an urgent referral system, most often for symptom management. About 40.0% of initial visits were outpatient rather than inpatient and there were no racial or other demographic differences in the setting of the first visit. Patients receiving cancer care in more recent years (P &lt; .001), who were younger (P = .025), and with non-genitourinary cancers (P = .005) were more likely to receive PM services. Also, patients who received PM were more likely to have a medical power of attorney (P &lt; .001) and living will (P &lt; .001) documented in the EMR. Conclusions: This study demonstrates that in centers with a robust PM team including an outpatient clinic, patients with advanced cancer are receiving early Palliative Medicine evaluation in accordance with the 2016 ASCO guidelines. In contrast to a previous study by Johnson et al our study shows that African-Americans were also equally referred and established with PM services. Our study is limited by the presence of a free-standing PM clinic rather than embedding into a cancer center which may assist with even earlier integration.
Role of PETCT in multiple myeloma: A 3 year data analysis of tertiary care center.
Authors: Neha Gupta, Dinesh Pendharkar
Journal: Journal of Clinical Oncology (2023)

e20030 Background: Bone involvement is one of the most common presentations of multiple myeloma, seen in about two-thirds of patients at the time of diagnosis. Therefore, imaging is an integral part of diagnosis for detection of lytic bone lesions and extra medullary disease. Evaluation of disease burden in both multiple myeloma and plasmacytoma as measured by PET/CT scan and response evaluation to induction therapy using PET based SUV changes is an important research topic. Methods: Single center prospective study done from 1st January,2020 to 30th June,2021 in Sarvodaya hospital and research center, Faridabad. All patients with multiple myeloma and solitary plasmacytoma coming to Sarvodaya hospital were eligible for the study. Total of 42 patients were enrolled into the study. PET-CT was done at baseline and post treatment as planned. Results: Out of 42 patients, 2 patients were diagnosed as solitary plasmacytoma and 40 patients were diagnosed as multiple myeloma. The median age of presentation was 64 years with male predominance (64.29%). PET-CT was done pre-treatment, On the basis of PET-CT findings it was seen that &lt; 3 focal lesions were seen in 24(57.14%) patients and &gt; 3 focal lesions were seen in 18(42.86%) of patients, based on SUV max, lesions with &lt; 4.2 SUV max value were seen in 23(54.77%) patients and lesions with &gt; 4.2 SUV max values were seen in 19(45.23%) patients. Presence of extra medullary disease was seen in 17(40.48%) of patients. 39(92.86%) patients were available for response analysis post treatment.3(7.14%) patients were expired during the study due to treatment complications and comorbidities. On the basis of PET-CT findings post treatment there was statistically significant response seen with p value of &lt; 0.05 in the number of focal lesions, lesions with SUV max and burden of extra medullary disease. Evaluation of response when assessed radio logically by PET-CT scan, it was seen that Complete response was found in 22(56.40%) patients, VGPR was seen in 4(10.25%) patients, PR was found in 12(30.77%) patients and PD was seen in 1(2.58%) patient. But the results of co-relation of PET-CT findings with survival outcomes were not significant. Conclusions: PET-CT plays a significant role in diagnosis and response assessment. But there is still no uniform criteria for quantification and visualization of FDG avid lesions for patients with multiple myeloma.
Cervical cancer risk factors, knowledge and attitudes towards HPV vaccine among coastal Kenyan women: A prospective cross-sectional survey.
Authors: Abeid Mohamed Athman Omar, Zahra Mohamed Ahmed, Raiham Sheikh, Abdurahman Abud Mohamed, Fatma Omar Amoody
Journal: Journal of Clinical Oncology (2023)

e22515 Background: Cervical cancer is the leading cause of death among women in Sub-Saharan Africa (SSA) despite being a preventable disease. Currently, there is a global rolling out of the human papillomavirus (HPV) vaccine among young girls. However, the knowledge and attitude of Cervical Cancer and the HPV vaccine remain unknown among women in SSA. Methods: We conducted a voluntary cross-sectional survey among adult women attending the cervical and breast cancer screening during Breast Cancer Awareness month in October 2022 at the Coast General Teaching Referral Hospital Regional Cancer Center, Kenya. The demographic, cervical cancer risk factors, knowledge, and attitudes to the HPV vaccine data were collected and analyzed using descriptive analysis. Results: Two hundred and fifty women participated in the survey, of which 48% were native coastal people. Their mean age was 39.3 ±12.4, and the majority (61%) of the participants were married. The most common age onset of sexual intercourse was 21-30 years (50%), followed by 16-20 years (41%), while 7% were virgins, and a quarter (n = 67) reported having multiple sexual partners. Most (90%) of the participants knew screening and early detection of cervical cancer are associated with better survival. Nevertheless, only a third had been screened previously for cervical cancer. Concerning the cause of cervical cancer, half of the patients (n = 126) knew cervical cancer is caused by HPV, and only 45% (n = 111) were aware of the free national HPV vaccination program, with only 5 participants having been vaccinated against HPV. The most commonly sighted reason for not being vaccinated was lack of knowledge of the HPV vaccine's existence (50%), a third was afraid of the vaccine’s side effects, 10% was due to lack of access, and 3%- were due to the vaccine’s age limit. With regards to the willingness to be vaccinated if they had qualified and the HPV vaccine is available for free, only two-thirds were willing to be vaccinated. However, most (90%) would recommend it to young girls. The few who would not recommend the vaccine to young girls were due to fear and lack of knowledge about the vaccine (73%). Conclusions: There is an unmet need for awareness and understanding of the HPV vaccine, and sensitization is needed to improve its uptake. In addition, it will be worth reviewing the age limit of HPV vaccination among Kenyan women as most women are sexually active after 20 years.
Characteristics and survival of secondary acute myeloid leukemia arising from myelodysplastic syndrome (MDS-sAML).
Authors: Diego Andres Adrianzen Herrera, Andrew Sparks, Akshee Batra, Neil A. Zakai
Journal: Journal of Clinical Oncology (2023)

e19075 Background: sAML is a heterogenous category including therapy-related AML, AML arising from MDS or myeloproliferative neoplasm, and other biologically distinct groups. Combining these as one entity likely masks important clinical and therapeutic differences. We defined the clinical profile and survival for MDS-sAML. Methods: The population consisted of patients (pts) with MDS identified in SEER-Medicare (2007-17) by ICD-O-3 histology codes and continuous Medicare parts A+B coverage. Transformation to leukemia was confirmed by at least 2 AML codes during follow up. Established algorithms identified MDS type and risk group, Charlson comorbidity index (CCI), and transfusion dependence for red blood cells (RBC) and platelets. Logistic regression identified risk factors for transformation to MDS-sAML. Kaplan-Meier estimation and multivariable Cox regression were used to analyze overall survival (OS). Results: Of 15,227 MDS pts, 1,871 transformed to AML. MDSsAML incidence varied by MDS risk group and histology. Time to transformation was shorter with higher risk groups. Younger age (odds ratio [OR] = 1.6, 95% confidence interval [95 CI]: 1.4-1.9), lower CCI (OR = 1.6, 95 CI: 1.4-1.9), higher risk (OR = 2.3, 95 CI: 2.0-2.5), transfusion dependence for RBC (OR = 1.2, 95% CI: 1.1-1.3) or platelets (OR = 2.5, 95 CI: 2.1-3.0), were associated with transformation (all respective p &lt; 0.05). Median OS (mOS) after transformation was 3.3 months. The 1- and 2-year OS rates for MDS-sAML were 25% and 12%. MDS-sAML survival varied by antecedent MDS histology and risk group, being longer for pts with antecedent low risk MDS (p &lt; 0.001). Sex, race, and CCI did not affect survival after transformation. Older age (hazard ratio [HR] = 1.5, 95 CI: 1.2-2.0), higher MDS risk (HR = 1.5, 95 CI: 1.2-1.9), RBC transfusion dependence (HR = 1.4, 95 CI: 1.3-1.6), and platelet transfusion dependence (HR = 1.5, 95 CI: 1.3-1.7), were associated shorter MDS-sAML survival (all respective p &lt; 0.05). Conclusions: Risk of MDS-sAML is substantial, with 5% AML transformation even in lower risk MDS histology. Real-world survival of MDS-sAML pts is dismal and lower than reported in clinical trials. Worse MDS risk group before transformation is associated with lower OS after developing AML. These data support a unique pathophysiology of MDS-sAML. [Table: see text]